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SYSTEM DEVIATIONS FROM REFERENCED NFPA STANDARDS Note: If service provided (i.e., periodic testing, maintenance, response, or coverage) is not in accordance with NFPA Standard specified, the details must be shown in this section.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

CONTROL AND TRANSMITTER UNITS Manufacturers and Model Numbers: Indicate model numbers and manufacturers of all control units and transmission devices. Do not include initiating device model numbers.

Control Unit:

Mfg:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Model

_________________________

Independent Transmitter Mfg:

_______________

Model:

________________________

(If applicable)

ALARM TRANSMISSION METHOD Complete for all remote monitoring locations except “NONE”

Multiplex

______

Direct Wire

_ _ _ _ _

Derived Channel

_____

Remote Radio System

_____

Radio Network/Transport System (Two Way) _____

Private Radio System

_ _ _ _ _

Radio Network/Transport System (One Way) _____

Digital Alarm Communicator

_____

Cellular Digital Alarm Communicator

_____

Transmitter (McCulloh) _____

Other Transmission Technologies

_________________

© 2012 UL LLC

5 – Revised 05/21/2007

UL Form No. CS-ASD-FAS

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